NCLEX-PN
Integumentary System NCLEX Questions Quizlet Questions
Extract:
Question 1 of 5
The nurse assesses that the client with partial-thickness burns over 50% of the total body surface area (TBSA) has gained weight and has generalized edema after the first 24 hours. The nurse should consider that the edema and weight gain are most likely related to which physiological processes?
Correct Answer: D
Rationale: Initially after a severe burn injury there is a loss of capillary integrity and a shift of fluid, sodium, and protein from the intravascular to the interstitial spaces. The body compensates for this interstitial hemoconcentration by retaining more fluid. Sodium is lost due to diuresis, and existing sodium tends to be diluted by an influx of fluid, so serum sodium levels will be decreased, not increased. Hgb and Hct levels may change in severe burns, but they are the result of the fluid shift, not the cause. Fluid volume deficit (not excess) is a major risk during this phase.
Question 2 of 5
When the nurse prepares the client for the myringotomy, which statement best explains the purpose of the procedure?
Correct Answer: B
Rationale: A myringotomy creates an opening for fluid drainage, relieving pressure.
Question 3 of 5
The 55-year-old client contracted chickenpox from his grandchild. The client had to be hospitalized because of the seriousness of the condition. Which complication is the client at risk for developing secondary to chickenpox?
Correct Answer: B
Rationale: Varicella pneumonia is a serious complication in adults with chickenpox, especially older adults. DVT, pericarditis, and scarring are less common.
Question 4 of 5
When the nurse reviews the client's health history, which symptom is directly related to the development of cataracts?
Correct Answer: A
Rationale: Cataracts cause a gradual loss of vision due to lens opacity.
Question 5 of 5
The nurse is caring for a client who is having silver nitrate dressings. Which lab values should the nurse monitor?
Correct Answer: D
Rationale: Silver nitrate can cause electrolyte imbalances, particularly hyponatremia and hypokalemia, requiring monitoring of serum electrolytes.